Cautious time awaits

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Just when you thought cancer is no longer a mortal fear, think again. Secondary malignancy (SM) cases are on the rise. This is an offset of chemotherapy and radiation therapies and manifest as diseases.

With advancements in diagnosis, cancer patients are surviving longer than before. There are about thirty million cancer survivors worldwide. However, cancer patients are at a higher risk of developing a secondary cancer. About 20 percent of long-term cancer survivors eventually develop a secondary cancer.
Not all secondary malignancies are caused by chemotherapy or radiation. Some secondary cancers of the lung, head and neck can be due to high-risk factors such as smoking. Breast and ovarian cancer can occur due to genetic reasons. The time these secondary malignancies occur can vary. It may take months for some and years for some others.
Some of the contributing risk factors include type of the cancer, age of the patient, chemotherapy, radiation, after stem-cell transplant and lifestyle changes such as smoking, excessive alcohol consumption, lack of exercise and diet.
Some chemotherapy and radiation therapy-related diseases include acute myeloid leukemia, acute lymphoblastic leukemia, myelo dysplastic syndrome, lymphomas, breast, thyroid, brain, basal cell cancers and sarcoma.
Chemotherapy medications that have been implicated in causing SMs are alkylating agents, anthracyclines, topoisomerase inhibitors II, antimetabolites and taxanes. Hodgkin disease survivors are more prone to develop leukemias, non-Hodgkin’s lymphoma, thyroid cancers, breast cancers and lung cancers.
With the advent of newer chemotherapies, targeted therapies and advanced radiation technologies, lesser side effects are being observed. However, there are few SMs reported during or after treatment. Doctors expect a decrease in risk of long-term complications including secondary cancers.
There is no specific time period for a relapse, so all cancer patients should have long-term regular follow-ups, perhaps lifelong after cancer treatment is completed as per the recommended guidelines to assess the occurrence of secondary cancers to effectively treat patients.
The least we can do to reduce cancer occurrence is by incorporating lifestyle changes, regular exercise and maintaining a healthy diet which is rich in fruits and vegetables.

— The writer is a consultant oncologist at HCG, Bengaluru